直覺手術 (ISRG) 2022 Q2 法說會逐字稿

Ladies and gentlemen, good afternoon. Thank you for standing by as today's conference assembled. Welcome to the Intuitive Surgical Quarter 2 2022 earnings release. (Operator Instructions) And as a reminder, today's conference is being recorded.

女士們、先生們，午安。感謝各位蒞臨今天的會議。歡迎參加直覺外科2022年第二季財報發表會。 （操作說明）再次提醒，今天的會議正在錄製中。

At this time, it's my pleasure to turn the conference over to our host, Head of Investor Relations with Intuitive Surgical, Mr. Brian King. Please go ahead.

現在，我很高興將會議交給我們的東道主，直覺外科公司投資者關係主管布萊恩金先生。請您開始吧。

Thank you. So good afternoon, and welcome to Intuitive's Second Quarter Earnings Conference Call. With me today, we have Gary Guthart, our CEO; and Jamie Samath, our CFO.

謝謝。下午好，歡迎參加Intuitive第二季財報電話會議。今天與我一起出席的有我們的執行長Gary Guthart和財務長Jamie Samath。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 3, 2022, and Form 10-Q filed on April 22, 2022. Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

在會議開始之前，我想告知各位，今天電話會議中提及的評論可能包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性已在提交給美國證券交易委員會（SEC）的文件中詳細描述，包括我們於2022年2月3日提交的最新10-K表格和於2022年4月22日提交的10-Q表格。您可以透過我們的網站或SEC網站查閱我們的SEC文件。投資者請勿過度依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website. Today's format will consist of providing you with highlights of our second quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights, Jamie will provide a review of our financial results, and I will discuss procedure and clinical highlights and provide our updated financial outlook for 2022. And finally, we will host a question-and-answer session.

請注意，本次電話會議的音訊回放可在我們的網站intuitable.com的「投資者關係」頁面下的「活動」欄位中找到。今天的新聞稿和補充財務數據表已發佈在我們的網站上。今天的會議流程如下：首先，我們將重點介紹今天早些時候發布的新聞稿中所述的第二季度業績；隨後進行問答環節。 Gary將介紹本季的業務和營運亮點；Jamie將回顧我們的財務表現；我將討論流程和臨床方面的亮點，並提供我們更新後的2022年財務展望。最後，我們將進行問答環節。

And with that, I will turn it over to Gary.

接下來，我將把麥克風交給蓋瑞。

Thank you for joining us today.

感謝您今天蒞臨。

Our Q2 results reflect both environmental and Intuitive's specific headwinds accompanied by underlying business strength. Procedures in the quarter grew 14% over last year despite pressure from COVID-driven lockdowns in China, our second largest market. Capital placements slowed from a year ago due to a combination of factors we described last quarter and which I will review shortly. Overall pressure from COVID lockdowns impacted procedures in the quarter modestly while reduced trade-ins and supply chain timing impacted our capital placements more significantly. The leading indicator of the health of our business, procedure demand, remains healthy.

我們第二季的業績反映了環境因素和Intuitive本身面臨的挑戰，同時也反映了我們業務的強勁基礎。儘管受到中國（我們的第二大市場）因新冠疫情實施封鎖措施的影響，本季手術量仍較去年同期成長14%。由於我們上季度已闡述的多種因素（我稍後將對此進行詳細說明），本季資本配置量較去年同期有所放緩。新冠疫情封鎖措施對本季手術量的影響不大，而以舊換新減少和供應鏈延遲則對資本配置量產生了更為顯著的影響。作為衡量我們業務健康狀況的領先指標，手術需求仍然保持良好。

Starting first with procedures. I am encouraged by 14% growth in the quarter, reflecting strength in U.S. general surgery and solid growth extending beyond urology outside the United States. U.S. procedure growth was led by bariatric surgery, cholecystectomy and colorectal procedures with continued growth in hernia repair. In OUS markets, procedures grew 22% in the quarter in spite of the COVID lockdown in China.

首先來看手術量。本季14%的成長令人鼓舞，這反映了美國一般外科的強勁表現，以及美國以外地區泌尿外科以外的穩健成長。美國手術量的成長主要得益於減重手術、膽囊切除術和結直腸手術，疝氣修補術也持續成長。儘管中國受到新冠疫情封鎖的影響，但美國以外地區的手術量在本季仍增加了22%。

Outside the U.S., we are seeing strength in urology now accompanied by diversified growth in other procedures. For example, in Japan, growth was strong in general surgery, including rectal resection. In the U.K. and Ireland, growth was strong in gynecology and general surgery. And in France, gynecology and general surgery experienced solid growth. System utilization in several OUS countries has been increasing in recent quarters as procedure adoption diversifies increasing value for our customers and for Intuitive. This is a result of the investments we made in key country markets starting several years ago.

在美國以外，我們看到泌尿科業務表現強勁，其他手術領域也呈現多元化成長。例如，在日本，包括直腸切除術在內的普通外科手術增長強勁。在英國和愛爾蘭，婦科和普通外科手術成長強勁。在法國，婦科和普通外科手術也實現了穩健成長。近幾個季度，隨著手術應用範圍的擴大，多個美國以外國家的系統利用率有所提高，這為我們的客戶和Intuitive公司創造了更多價值。這得歸功於我們幾年前開始在關鍵國家市場的投資。

Turning to da Vinci capital placements. We placed 279 systems in the quarter, down from 328 in Q2 2021. In the da Vinci business, we see 3 causes for the decline in placements relative to a year ago. As our customers have standardized on Generation 4 da Vinci systems, the installed base of third generation systems has declined, lowering the trade-in population, particularly in the United States.

接下來談談達文西手術系統的安裝情形。本季我們共安裝了279套系統，低於2021年第二季的328套。達文西手術系統安裝量較去年同期下降的原因主要有三點。由於我們的客戶普遍採用第四代達文西系統，第三代系統的裝機量減少，導致以舊換新需求下降，尤其是在美國。

Next, supply chain disruption continued in the quarter with semiconductor component delays impacting the timing of system builds, leaving us challenged to match some customer orders at quarter end. Lastly, we've seen hospital capital spending pressure grow in our part of the capital equipment space over the past 2 quarters, incenting customers to seek efficiency gains on existing capital before acquiring new capacity. Component supply constraints remain a risk, and our operating teams are working hard to shelter our customers for most of these pressures.

其次，本季供應鏈中斷持續，半導體元件的延遲交付影響了系統組裝的時間安排，導致我們在季度末難以滿足部分客戶訂單的需求。最後，過去兩個季度，我們所負責的醫院資本支出壓力持續成長，促使客戶在購買新設備之前，優先考慮提高現有設備的效率。元件供應限制仍然是一個風險，我們的營運團隊正在努力幫助客戶應對這些壓力。

Capital placements in more mature markets are a mix of core demand for procedures and trade-in opportunities. The need for high-quality robotic-assisted surgery remains healthy. Incremental capital demand at the customer is a function of system utilization and procedure growth.

在較成熟的市場中，資本投入既包括核心手術的需求，也包括以舊換新的機會。對高品質機器人輔助手術的需求依然強勁。客戶的增量資本需求取決於系統利用率和手術量的成長。

On the system utilization side, our compound annual growth rate remains at historic levels of 5% over the past 3-year period. System utilization in the U.S. over the past year was slightly down as procedure growth rate over the past year roughly matched the system installed base growth. In contrast, system utilization in many OUS markets, has been rising as procedures diversify. Overall, we prioritize system utilization growth for customers as it increases the value to them of their investments and is aligned with long-term health for Intuitive.

在系統利用率方面，過去三年我們的複合年增長率維持在5%的歷史高點。過去一年，美國市場的系統利用率略有下降，因為手術量成長率與系統裝機量成長率大致相當。相較之下，隨著手術種類日益豐富，許多美國境外市場的系統利用率一直在上升。整體而言，我們優先考慮客戶的系統利用率成長，因為這不僅能提升客戶的投資價值，也符合Intuitive的長期健康發展。

Turning to our innovation engines and new products and services, we placed 41 Ion systems, up from 20 in Q2 of last year. Given its stage of maturity, Ion capital demand precedes procedure growth as hospitals seek to build initial capability. With the Ion clinical installed base now at 204 systems, Ion utilization has been growing nicely along with encouraging early capital placements.

在創新引擎和新產品及服務方面，我們部署了 41 套 Ion 系統，高於去年第二季的 20 套。鑑於 Ion 系統已處於成熟階段，其資本需求先於手術量成長，因為醫院需要建立初始能力。目前 Ion 系統的臨床裝置量已達 204 套，其利用率穩定成長，早期資本投入也令人鼓舞。

We received 510(k) clearance for our integration of Ion with Siemens Cios Spin cone-beam CT. This combination improves registration and targeting precision for Ion in the lung and is being well received by our customers. We remain focused on strengthening clinical outcomes in lung care, a fantastic customer experience and operational excellence in the Ion program.

我們已獲得 510(k) 許可，可將 Ion 與西門子 Cios Spin 錐束 CT 系統整合。這一組合提高了 Ion 在肺部成像的配準和靶向精度，並受到了客戶的好評。我們將持續致力於提升 Ion 計畫在肺部照護方面的臨床療效、提供卓越的客戶體驗和營運效率。

In our multiport ecosystem, we initiated our first phase U.S. launch of our 8-millimeter stapler designed to work in small anatomical spaces, for example, in thoracic surgery. Early customer feedback has been encouraging. In China, we're preparing to launch our SureForm 45- and 60-millimeter staplers and our latest endoscope, Endoscope Plus. All 3 will continue to support growth in general surgery and thoracic procedures.

在我們的多端口生態系統中，我們已在美國啟動了首批8毫米吻合器的上市，該產品專為狹小解剖空間（例如胸腔外科手術）而設計。早期客戶回饋令人鼓舞。在中國，我們正準備推出SureForm 45毫米和60毫米吻合器以及我們最新的內視鏡—Endoscope Plus。這三款產品將繼續支持一般外科和胸腔外科手術領域的成長。

For da Vinci SP, we have expanded the number of colorectal IDE sites to help accelerate accrual and we submitted another regulatory package for SP imaging and accessories in Japan as we work on the necessary clearances to support an SP launch in the country. For our digital tools, Intuitive Hub installs grew nicely again in the quarter, and we're focused on ensuring outstanding customer experiences with data capture and media management, along with increasing utilization over time.

對於達文西SP手術系統，我們擴大了結直腸IDE臨床試驗中心的數量，以加快病患招募。同時，我們已向日本提交了另一份SP成像系統及配件的監管申請文件，目前正在努力獲得必要的審批，以支持SP系統在日本的上市。在數位化工具方面，Intuitive Hub的安裝量在本季再次實現了良好的成長。我們致力於確保用戶在數據採集和媒體管理方面獲得卓越的體驗，並持續提高其使用率。

On spending, we are committed to our innovation programs because we believe the forward opportunity for our products and services are important to our customers and to the company. We have some natural shock absorbers that decreased some of our variable spending as a result of the slowdown in da Vinci capital placements. We are also planning for decelerating spend growth after we complete some infrastructure projects we need to support the company's expansion. Given our confidence in the future of our business, we have also returned cash to shareholders in the form of buybacks in the quarter.

在支出方面，我們致力於創新項目，因為我們相信，我們產品和服務的未來發展機會對客戶和公司都至關重要。由於達文西資本配置放緩，我們採取了一些天然的緩衝措施，從而減少了部分變動支出。此外，在完成一些支持公司擴張的基礎設施項目後，我們也計劃放緩支出成長。鑑於我們對公司未來業務的信心，本季我們也以股票回購的形式向股東返還了部分現金。

I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

現在我將時間交給傑米，他將更詳細地向大家介紹我們的財務狀況。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis. I will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website.

午安.我會先介紹我們依照非GAAP準則或備考財務報表編製的績效重點。稍後，我也會在我的發言稿中概述我們按GAAP準則編制的業績。我們網站上已公佈備考財務報表與GAAP財務報表的調節表。

Q2 procedure growth of 14% reflected an increase in U.S. procedures of 11% and OUS procedure growth of 22%. As a reminder, procedures in the U.S. in the second quarter of last year included a recovery of procedures that were delayed as a result of the significant impact of the Omicron variants. Brian will provide additional procedure commentary later in the call.

第二季手術量成長14%，其中美國手術量成長11%，美國境外手術量成長22%。需要注意的是，去年第二季度美國手術量中包含了因奧密克戎變異株的嚴重影響而延誤的手術的恢復情況。布萊恩將在稍後的電話會議中提供更多關於手術量的評論。

We placed 279 systems in the second quarter as compared to 328 systems in the second quarter of 2021 and 311 systems last quarter. Q2 system placements were 15% lower than the second quarter of 2021, primarily due to a significant decline in trade-in transactions. There were 56 trade-in transactions in the quarter as compared to 125 in Q2 of 2021, reflecting the decline in the number of SIs remaining in the installed base.

第二季我們共安裝了 279 套系統，而 2021 年第二季為 328 套，上季為 311 套。第二季系統安裝量比 2021 年第二季下降了 15%，主要原因是舊機置換交易量大幅下降。本季共有 56 筆舊機置換交易，而 2021 年第二季為 125 筆，這反映出現有系統整合商 (SI) 數量的減少。

The supply chain environment continues to be challenging. And during the quarter, we experienced delays in the supply of certain semiconductor components that caused manufacturing output da Vinci systems to be later in the quarter than historical norms. As a result, a number of systems that we would have expected to place in the latter part of June experienced minor delays and were shipped and installed in July.

供應鏈環境仍充滿挑戰。本季度，部分半導體元件的供應出現延遲，導致達文西手術系統的生產交付時間晚於往年同期。因此，部分原計劃於6月下旬交付的系統出現輕微延誤，最終於7月完成出貨和安裝。

We indicated on last quarter's call that we had experienced a softening in the U.S. capital pipeline. That softness persisted in Q2. Financial pressures have increased on hospitals, given higher inflation, increasing interest rates, supply chain challenges and continued staffing shortages. Some of the larger IDNs have indicated that as a consequence of the financial pressures they face, they are lowering their capital investment plans and tightening operational budgets.

我們在上季電話會議中指出，美國資本項目儲備有所放緩。這種疲軟態勢在第二季依然存在。由於通膨加劇、利率上升、供應鏈挑戰以及持續的人員短缺，醫院面臨的財務壓力不斷增加。一些規模較大的綜合醫療網絡（IDN）表示，由於面臨財務壓力，他們正在降低資本投資計畫並收緊營運預算。

We expect that demand for capital, particularly in the U.S., will be impacted while macro conditions remain challenging. Where a particular hospital requires additional da Vinci capacity, given growth in their programs, we will leverage our flexible acquisition models to meet the financial objectives of our customers.

我們預計，在宏觀經濟情勢依然嚴峻的情況下，資本需求，尤其是在美國，將受到影響。如果某家醫院因其專案成長而需要增加達文西手術系統的容量，我們將利用我們靈活的收購模式來滿足客戶的財務目標。

Given the system placements in Q2, the installed base of da Vinci systems grew approximately 13% year-over-year. Utilization of clinical systems in the field, measured by procedures per system, increased approximately 1% compared to last year. Using a 3-year compound annual growth rate, second quarter utilization grew almost 5%, which is in line with historical averages.

根據第二季的系統安裝情況，達文西手術系統的裝機量年增約13%。以每台系統完成的手術量衡量，臨床系統的現場使用率較去年同期增加約1%。採用三年複合年增長率計算，第二季使用率成長近5%，與歷史平均水準基本持平。

In more mature markets like the U.S., capital demand is sensitive to procedure growth, and therefore, we monitor changes in system utilization closely. As a result of our procedure and capital performance, Q2 revenue was $1.52 billion, an increase of 4% from the second quarter of 2021. On a constant currency basis, second quarter revenue grew approximately 6% over last year. It is worth highlighting that recurring revenue grew 14% year-over-year to $1.24 billion, representing 81% of total revenue.

在美國等較成熟的市場，資本需求對業務成長較為敏感，因此我們密切關注系統利用率的變化。由於業務和資本的良好表現，第二季營收為15.2億美元，較2021年第二季成長4%。以固定匯率計算，第二季營收較去年同期成長約6%。值得一提的是，經常性收入年增14%至12.4億美元，佔總營收的81%。

Additional revenue statistics and trends are as follows: in the U.S., we placed 150 systems in the second quarter, lower than the 213 in Q2 of 2021, reflecting a decline of 59 systems associated with trade-in transactions, a softer demand environment and the delay of some system placements into July. The remaining installed base of Si Systems in the U.S. is approximately 230 systems.

其他營收統計數據和趨勢如下：在美國，我們第二季安裝了150套系統，低於2021年第二季的213套，這反映出因以舊換新交易而減少了59套系統，以及市場需求疲軟和部分系統安裝推遲到7月份。目前，Si Systems在美國的剩餘裝置量約為230套系統。

Outside the U.S., we placed 129 systems in the second quarter compared with 115 in the second quarter of 2021. Current quarter system placements included 78 into Europe, 18 into Japan and 15 into China, compared with 63 into Europe, 16 into Japan and 19 into China in the second quarter of 2021. As of the end of Q2 2022, there were 48 systems remaining under the current quota in China, which is also available to competitors that have received local regulatory clearance.

除美國以外，我們在第二季共安裝了129套系統，而2021年第二季為115套。本季系統安裝包括歐洲78套、日本18套和中國15套，而2021年第二季分別為歐洲63套、日本16套和中國19套。截至2022年第二季末，中國市場現有配額下還剩48套系統，這些配額也提供給已獲得當地監管部門核准的競爭對手。

Globally, trade-in transactions represented 20% of placements in the quarter compared to 38% for full year 2021 and 48% for full year 2020. As we have previously indicated, given the lower number of older generation systems in the field, we expect the volume of trade-ins to be significantly lower in 2022 as compared to last year.

從全球來看，本季以舊換新交易佔總交易量的20%，而2021年全年這一比例為38%，2020年全年為48%。正如我們先前所指出的，鑑於目前市場上老一代系統的數量較少，我們預計2022年的以舊換新交易量將比去年大幅下降。

Leasing represented 42% of Q2 placements compared with 35% last quarter and 33% in the second quarter of 2021. The higher lease mix primarily reflected an increase in the proportion of OUS customers that lease the system in the quarter versus purchased, driven in particular by customers in Europe. While leasing will fluctuate from quarter-to-quarter, we continue to expect that the proportion of placements under operating leases will increase over time.

第二季租賃佔比為42%，高於上季的35%和2021年第二季的33%。租賃比例上升主要反映了本季海外客戶租賃系統比例較購買比例的增加，尤其受到歐洲客戶的推動。儘管租賃比例會隨季度波動，但我們仍預期經營租賃的佔比會隨著時間的推移而增加。

Second quarter system average selling prices were $1.50 million, slightly lower than the $1.54 million last quarter. Although system ASPs were roughly flat, lower trading volumes benefit Q2 ASP offset by an unfavorable impact from the stronger U.S. dollar and a higher mix of lower price X systems, primarily driven by customers in Europe.

第二季系統平均售價為150萬美元，略低於上季的154萬美元。儘管系統平均售價基本持平，但交易量下降對第二季平均售價的提振作用被美元走強和低價X系統佔比上升（主要由歐洲客戶推動）帶來的不利影響所抵消。

We recognized $22 million of lease buyout revenue in the second quarter compared with $16 million last quarter and $26 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so. Instrument and accessory revenue per procedure was approximately $1,900 per procedure compared with $1,870 last quarter and $1,940 in the second quarter of 2021. The year-over-year decrease primarily reflects the benefit of stocking orders in Q2 of 2021 associated with the launch of our extended use instruments program and an unfavorable FX impact from the stronger U.S. dollar.

第二季我們確認了2,200萬美元的租賃買斷收入，而上一季為1,600萬美元，去年同期為2,600萬美元。租賃買斷收入季度間波動較大，且這種情況可能還會持續。每台手術的器械及配件收入約為1,900美元，而上一季為1,870美元，2021年第二季為1,940美元。年減主要反映了2021年第二季因推出延用器材計畫而產生的庫存訂單帶來的收益，以及美元走強帶來的不利匯率影響。

The sequential increase reflects a higher proportion of stapling and advanced energy revenue. Revenue for these categories combined grew 22% as compared to the second quarter of last year. We placed 41 Ion systems in the quarter as compared to 20 Ion placements in the second quarter of last year. The installed base of Ion systems is now 204 systems, of which 90 are under operating lease arrangements.

環比成長反映了釘合和先進能源業務收入佔比的提高。與去年第二季相比，這兩類業務的營收合計成長了22%。本季我們安裝了41套Ion系統，而去年第二季為20套。目前Ion系統的裝機量為204套，其中90套為經營租賃。

Second quarter Ion procedures of approximately 5,200 increased 251% compared to the second quarter of 2021. Ion is in the new MDR regulatory review process in Europe and our efforts to pursue a submission in China continue to make progress. Five of the systems placed in the second quarter were SP systems, resulting in an installed base of 111. Second quarter SP procedures grew approximately 28% year-over-year.

第二季 Ion 系統手術量約 5,200 例，較 2021 年第二季成長 251%。 Ion 系統目前正處於歐洲新的 MDR 監管審查流程中，同時我們在中國提交申請的工作也持續進行中。第二季安裝的系統中有 5 台為 SP 系統，累計安裝量達 111 台。第二季 SP 系統手術量年增約 28%。

One of the areas of potential clinical differentiation for SP is in narrow access surgery, for example, in transoral robotic surgical or TORS procedures. For malignant TORS procedures, based on the last 4 quarters, we estimate SP market share in the U.S. to be just under 20%. Growth of the SP platform will continue to be gated by additional clinical indications and clearances in markets beyond the U.S. and Korea.

SP技術的潛在臨床差異化應用領域之一是狹窄通道手術，例如經口機器人手術（TORS）。根據過去四個季度的數據，我們估計SP在美國惡性腫瘤TORS手術的市佔率略低於20%。 SP平台的成長將繼續受到美國和韓國以外市場更多臨床適應症和批准的限制。

Moving on to the rest of the P&L. Pro forma gross margin for the second quarter of 2022 was 69.2% compared with 71.7% for the second quarter of 2021 and 69.8% last quarter. Pro forma gross margin was lower primarily as a result of the stronger U.S. dollar, higher logistics costs, increased component pricing and increased fixed costs relative to revenue as we invest in our infrastructure and manufacturing capacity to serve our long-term needs.

接下來來看損益表的其他部分。 2022年第二季的備考毛利率為69.2%，而2021年第二季為71.7%，上一季為69.8%。備考毛利率下降的主要原因是美元走強、物流成本上升、零件價格上漲以及固定成本佔收入的比例增加，因為我們投資於基礎設施和生產能力以滿足長期需求。

Pro forma operating expenses increased 23% compared with the second quarter of 2021. The increase in second quarter operating expenses from a year ago reflected an increase in headcount, higher R&D-related project costs and higher travel costs, including the impact of inflation. Given the early stages of our newer platforms, Ion and SP and our digital ecosystem, we expect to continue to invest in R&D, given the return profile of these investments. Spending in SG&A will be more closely linked to our procedure and revenue performance, and we will continue to pursue plans to invest in infrastructure and business process automation to ensure we can efficiently and effectively scale.

經調整後的營運費用較2021年第二季成長23%。第二季營運費用較上年同期成長主要反映了員工人數增加、研發相關項目成本上升以及差旅費用上漲（包括通貨膨脹的影響）。鑑於我們新平台Ion和SP以及數位生態系統尚處於早期階段，考慮到研發投資的回報前景，我們預計將繼續加大研發投入。銷售、管理及行政費用將與我們的流程和收入表現更加緊密地掛鉤，我們將繼續推進基礎設施和業務流程自動化方面的投資計劃，以確保我們能夠高效地擴展業務規模。

Pro forma operating margin for Q2 was 35% as compared to 40% for the full year 2021. As compared to the second quarter of last year, the net impact of FX, inflation and manufacturing inefficiencies associated with the supply chain environment is a reduction in operating margin of approximately 2%. Our pro forma tax rate -- effective tax rate for the second quarter was 22.3%, in line with our expectations.

第二季備考營業利益率為35%，而2021年全年為40%。與去年第二季相比，匯率、通貨膨脹以及供應鏈環境相關的生產效率低下等因素的淨影響導致營業利潤率下降約2%。第二季備考實際稅率為22.3%，符合預期。

Second quarter 2022 pro forma net income was $415 million or $1.14 per share compared with $475 million or $1.30 per share for the second quarter of 2021. Capital expenditures in Q2 were $131 million, primarily comprised of infrastructure investments to expand our facilities footprint, increased manufacturing capacity and automation of certain production lines.

2022 年第二季備考淨收入為 4.15 億美元，即每股 1.14 美元，而 2021 年第二季為 4.75 億美元，即每股 1.30 美元。第二季資本支出為 1.31 億美元，主要包括用於擴大設施規模、提高製造能力和實現某些生產線自動化的基礎設施投資。

I will now summarize our GAAP results. GAAP net income was $308 million or $0.85 per share for the second quarter of 2022 compared with GAAP net income of $517 million or $1.42 per share for the second quarter of 2021. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee stock awards, employee stock-based compensation, amortization of intangibles and gains and losses on strategic investments.

現在我將總結我們的GAAP業績。 2022年第二季GAAP淨利為3.08億美元，即每股0.85美元，而2021年第二季GAAP淨利為5.17億美元，即每股1.42美元。備考淨利潤與GAAP淨利潤之間的調整項已在我們的網站上列出並量化，其中包括與員工股票獎勵、員工股票期權激勵、無形資產攤銷以及戰​​略投資損益相關的超額稅收優惠。

We ended the quarter with cash and investments of $8.2 billion compared with $8.4 billion at the end of Q1. The sequential reduction in cash and investments primarily reflected share repurchases and capital expenditures, partially offset by cash from operating activities. Our capital allocation priorities remain consistent and are as follows: first, to organically invest in the business, given the significant opportunities we see to develop differentiated technology and drive adoption of our products. Second, to acquire external technology that creates value for our customers and/or accelerate development time lines or acquisitions that accelerate our growth. Third, we return excess cash to shareholders and look to do so efficiently.

本季末，我們的現金及投資總額為82億美元，而第一季末為84億美元。現金及投資的環比減少主要反映了股票回購和資本支出，部分被經營活動產生的現金流所抵銷。我們的資本配置優先事項保持不變，具體如下：首先，鑑於我們看到了開發差異化技術和推動產品普及的巨大機遇，我們將對業務進行內生性投資。其次，我們將收購能夠為客戶創造價值和/或加速產品研發進度的外部技術，或進行能夠加速我們成長的收購。第三，我們將多餘的現金回饋給股東，並力求有效率地完成這個過程。

In Q2, we repurchased 2.2 million of our shares at an average price of $224 per share for a total expenditure of $500 million. Concurrent with today's earnings release, our Board of Directors have improved an increase to the share repurchase authorization to $3.5 billion.

第二季度，我們以每股平均224美元的價格回購了220萬股股票，總支出為5億美元。在今天發布財報的同時，我們的董事會已將股票回購授權額度提高至35億美元。

And with that, I would like to turn it over to Brian, who will discuss clinical highlights and provide our updated outlook for 2022.

接下來，我將把發言權交給布萊恩，他將討論臨床亮點並提供我們最新的 2022 年展望。

Thank you, Jamie. Our overall second quarter 2022 procedure growth was 14% compared to 68% for the second quarter of 2021, which we believe benefited from a number of procedures which had previously been deferred due to COVID-19. The 3-year compound annual growth rate was 16% between the second quarter of 2019 and second quarter of 2022. In the U.S., second quarter 2022 procedure growth was 11% year-over-year compared to 77% for the second quarter of 2021 and 16% last quarter. On a 3-year compound annual growth basis, U.S. procedure growth was 14%.

謝謝Jamie。我們2022年第二季的整體手術量成長了14%，而2021年第二季為68%，我們認為這得益於先前因新冠疫情而被推遲的一些手術得以恢復。 2019年第二季至2022年第二季的三年複合年增長率為16%。在美國，2022年第二季的手術量年增11%，而2021年第二季為77%，上一季為16%。以三年複合年增長率計算，美國手術量成長率為14%。

Q2 procedure growth continued to be driven by general surgery, with particular strength in bariatrics, cholecystectomy and colorectal, while hernia and foregut were also strong contributors. Growth in mature urology and gynecology procedures also continue but at a moderate pace in the low single digits. Outside of the U.S., second quarter procedure volume grew approximately 22% compared with 51% for the second quarter of 2021 and 25% last quarter. Despite COVID-related restrictions in China, on a 3-year compound annual growth basis, procedure growth was 20%.

第二季手術量成長持續由一般外科手術推動，其中減重手術、膽囊切除術和結直腸手術表現尤為強勁，疝氣和上消化道手術也貢獻顯著。泌尿科和婦科成熟手術量也持續成長，但成長速度較為溫和，僅為個位數低點。除美國以外，第二季手術量成長約22%，2021年第二季為51%，上季為25%。儘管中國受到新冠疫情相關限制的影響，但以三年複合年增長率計算，手術量仍增加了20%。

Turning to Europe. Procedure growth was led by strong growth in Italy, U.K. and Germany. In all 3 regions noted, procedure growth was strong in general surgery and gynecology. In Italy, growth in these procedures outside of urology was led by general surgery, specifically in colorectal and HPV procedures. In Germany, growth in these categories was led by early stage growth in colorectal surgery and benign hysterectomy. Year-over-year procedure growth in these non-neurology procedures was almost 3x higher than urology. While in the U.K., benign hysterectomy and colorectal resection experienced strong early-stage growth.

再來看歐洲。手術量的成長主要由義大利、英國和德國的強勁成長帶動。在上述三個地區，一般外科和婦科手術量均呈現強勁成長。在義大利，除泌尿外科外，其他手術量的成長主要由一般外科推動，特別是大腸直腸手術和HPV相關手術。在德國，這些手術量的增長主要由結直腸手術和良性子宮切除術的早期增長所推動。這些非神經外科手術的年增長率幾乎是泌尿科手術的三倍。而在英國，良性子宮切除術和結直腸切除術的早期成長勢頭強勁。

In Asia, we experienced strong growth in Japan, while in China, procedures remain below expectations as government restrictions continued due to COVID infections that persisted throughout most of the quarter. In Japan, growth in general surgery and gynecology continued to be strong with robust growth, specifically in benign hysterectomy, rectal resection and gastrectomy. In addition, prostatectomy continued with solid double-digit growth, reflecting a recovery when compared to the prior year, which was constrained by COVID. Further contributing to procedure strength was early growth in the adoption of newly reimbursed procedures namely colon resection and nephrectomy procedures.

在亞洲，日本的業務成長強勁，而中國的業務成長則低於預期，原因是受新冠疫情持續影響，政府限制措施仍在繼續，疫情幾乎貫穿了整個季度。在日本，一般外科和婦科手術的成長動能依然強勁，尤其是良性子宮切除術、直腸切除術和胃切除術。此外，攝護腺切除術也維持了兩位數的穩健成長，與去年受疫情影響較大的情況相比，已有所復甦。結腸切除術和腎切除術等新納入醫療保險的手術計畫早期取得的成長也進一步推動了業務成長。

In China, second quarter procedure growth continued to be negatively impacted by regional lockdowns due to ongoing COVID infections that affected many large cities throughout most of the quarter. Despite the restrictions, China experienced modest year-over-year growth and began to show signs of a return to normal run rates in June.

在中國，第二季手術量成長持續受到新冠疫情持續蔓延導致的區域封鎖措施的負面影響，疫情在第二季的大部分時間影響了許多大城市。儘管受到限制，中國仍實現了同比小幅成長，並在6月開始顯現出恢復正常成長的跡象。

Now turning to the clinical side of our business. Each quarter on these calls, we highlight certain recently published studies that we deem to be notable. However, to gain a more complete understanding of the body of evidence, we encourage all stakeholders to thoroughly review the extensive detail of scientific studies that have been published over the years. Earlier this year, Doctors Sarah Diaz and Robert Cleary from St. Joseph Mercy Hospital Ann Arbor, along with Doctors Yongjin Lee and Amir Bastawrous from the Swedish Cancer Institute in Seattle, Washington and in collaboration with Intuitive, published a real-world body of evidence comparing health care utilization outcomes and payer/patient expenditures associated with open and minimally invasive colectomy for benign disease. Notably, this analysis also included a comparison of laparoscopic and da Vinci approaches.

現在我們來談談業務的臨床方面。每個季度，我們都會在這些電話會議上重點介紹一些我們認為值得關注的近期發表的研究。然而，為了更全面地了解現有證據，我們鼓勵所有利害關係人仔細審查多年來發表的大量科學研究。今年早些時候，來自安娜堡聖約瑟夫慈悲醫院的Sarah Diaz醫生和Robert Cleary醫生，以及來自華盛頓州西雅圖瑞典癌症研究所的Yongjin Lee醫生和Amir Bastawrous醫生，與Intuitive公司合作，發表了一項真實世界研究，比較了良性疾病開放式結腸切除術和微創結腸切除術的醫療資源利用結果以及支付方/患者支出。值得注意的是，這項分析還包括腹腔鏡手術和達文西機器人手術的比較。

Utilizing the IBM MarketScan commercial claims and encounter database, this study included over 10,000 adult patients who between January 2013 and December 2018 underwent an elective inpatient colectomy for a benign condition with over 2,500 patients in the open group and over 6,000 subjects in the laparoscopic group and over 1,000 patients in the da Vinci Group. Through an inverse propensity treatment weighted analysis, the minimally invasive approach demonstrated a lower total health care expenditure across all time frames analyzed from the surgical procedure through 365 days post procedure, with lower average total expenditures ranging from $2,300 to $8,100.

本研究利用IBM MarketScan商業索賠和就診資料庫，納入了2013年1月至2018年12月期間因良性疾病接受擇期住院結腸切除術的10,000多名成年患者。其中，開放手術組超過2,500名患者，腹腔鏡手術組超過6,000名患者，達文西手術組超過1,000名患者。透過逆傾向性評分加權分析，結果顯示，在從手術到術後365天的所有分析時間段內，微創手術的總醫療支出均低於開放性手術，平均總支出降低2,300美元至8,100美元。

With regards to resource utilization, the minimally invasive approach demonstrated an approximately 2-day lower length of stay with these patients less likely to be readmitted, visit the emergency department or visit the outpatient department within 365 days from the procedure. The reduction in health care use among minimally invasive patients translated to an additional savings over $5,700 and over 2 fewer days missed from work for health care visits.

在資源利用方面，微創手術可使病患住院時間縮短約2天，且術後365天內再次入院、急診就診或門診就診的可能性也較低。微創手術患者醫療資源利用率的降低，轉化為超過5700美元的額外支出，並減少了因就醫而耽誤的工作時間超過2天。

Within the MIS category when comparing laparoscopic and da Vinci approaches, da Vinci had a 70% lower risk of conversion to open with over a half day shorter length of stay and patients were less likely to have an outpatient hospital visit within 1 year of the procedure. Of note, patients who had a conversion to open had a longer length of stay, higher hospital payments and were more likely to have a readmission for hospital visit within 1 year of the procedure. The reduction in conversion is translated to an additional savings of approximately $4,800 and 1.5 fewer days of missed work due to health care visits.

在微創手術（MIS）類別中，比較腹腔鏡手術和達文西機器人手術，達文西機器人手術的開腹手術轉換風險降低了70%，住院時間縮短了半天以上，且患者術後一年內門診就診的可能性更低。值得注意的是，轉為開腹手術的患者住院時間較長，住院費用較高，且術後一年內再次入院的可能性也較高。開腹手術轉換風險的降低可節省約4,800美元，並減少因就醫而耽誤的工作時間1.5天。

The authors concluded in part that minimally invasive colectomy is associated with lower mean health care expenditures and less mean health care resource utilization compared to the open approach for benign disease, with a shorter mean length of stay and conversion to open rate observed with the da Vinci approach.

作者們得出的部分結論是，與良性疾病的開放式手術相比，微創結腸切除術與較低的平均醫療保健支出和較少的平均醫療保健資源利用相關，並且使用達文西手術觀察到的平均住院時間和轉為開放式手術的比例也較短。

I will now turn to our financial outlook for 2022. Starting with procedures. On our last call, we forecast full year 2022 procedure growth within a range of 12% to 16%. We are now increasing our forecast and expect full year 2022 procedure growth of 14% to 16.5%. This range continues to reflect the uncertainty associated with the course of the pandemic. The low end of the range assumes increasing COVID hospitalization and staffing pressure at hospitals for the remainder of the year. At the high end of the range, we assume COVID-19-related hospitalizations around the world continue to decline throughout the remainder of 2022, and there are no additional significant impacts from further resurgences. The range does not reflect significant material supply chain disruptions or hospital capacity constraints similar to what we experienced at the start of the pandemic.

接下來，我將談談我們對2022年的財務展望。首先是手術量。在上一次電話會議上，我們預測2022年全年手術量成長率介於12%至16%之間。現在，我們上調了預測，預計2022年全年手術量成長率將達到14%至16.5%。這一預測範圍仍反映了疫情發展帶來的不確定性。預測範圍的下限假設今年剩餘時間內新冠肺炎住院人數將持續增加，醫院人員配備壓力也將增加。預測範圍的上限則假設2022年剩餘時間內全球新冠肺炎相關住院人數將持續下降，且不會出現疫情反彈帶來的其他重大影響。此預測範圍並未考慮類似疫情初期那樣嚴重的物資供應鏈中斷或醫院容量限制。

While procedure growth so far in the first half of 2022 has been healthy, the capital pipeline in the U.S. has been softer than in prior periods, mainly due to a lower number of Si Systems in the installed base available for trade-in and macro-related headwinds creating pressure on the hospital capital spending. Capital placements in more mature markets are a function of procedure demand that is moderated by system utilization growth and trade-in opportunities.

儘管2022年上半年手術量增長勢頭良好，但美國的資本投入卻比以往有所放緩，這主要是由於可供以舊換新的已安裝Si系統數量減少，以及宏觀經濟逆風給醫院資本支出帶來壓力。在較成熟的市場，資本投入取決於手術需求，而係統利用率成長和以舊換新機會則會對此產生影響。

While trade-in opportunities have declined, the core demand for procedures continues to be healthy and system utilization has been increasing. With a 3-year compound annual growth rate in procedures of 16% from Q2 of 2019 to Q2 of 2022 and installed base growth of 11% over the same period, utilization of installed systems has continued to increase through the pandemic and first half of 2022. This is increasing the value derived from the existing installed base for our customers and for us. As we look ahead, we expect these capital dynamics to continue for the foreseeable future.

儘管以舊換新機會減少，但核心手術需求依然強勁，系統利用率也不斷提高。 2019年第二季至2022年第二季度，手術量三年複合年增長率達16%，同期裝機量成長率達11%。在疫情期間以及2022年上半年，已安裝系統的使用率持續成長。這提升了現有裝機量為客戶和我們本身帶來的價值。展望未來，我們預計這種資本動態將在可預見的未來持續下去。

Turning to gross profit. On our last call, we forecast our 2022 full year pro forma gross profit margin to be within 69% and 70.5%. We are now refining our estimate of pro forma gross profit margin to be within 69% and 70% of net revenue. Given the ongoing impact of higher input costs related to supply chain and the impact from a stronger U.S. dollar, we would expect to be towards the lower end of that range. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trading mix, fluctuations in foreign currency rates and the impact of new product introductions.

接下來談談毛利。在上一次電話會議上，我們預測2022年全年備考毛利率將在69%至70.5%之間。現在，我們將備考毛利率的預估調整為淨收入的69%至70%。鑑於供應鏈相關投入成本持續上漲以及美元走強的影響，我們預期實際毛利率將接近該區間的下限。實際毛利率將因產品、地區和貿易組合、外匯匯率波動以及新產品上市的影響而逐季波動。

With respect to operating expenses, on our last call, we forecast pro forma operating expense growth to be between 23% and 27%. We are refining our estimate and now expect our full year pro forma operating expense growth to be between 23% and 25%. We are refining our estimate for noncash stock compensation expense to range between $520 million to $540 million in 2022. We are also refining our estimate for other income, which is comprised mostly of interest income, to total between $60 million and $70 million in 2022, an increase from our previous estimate of $50 million and $60 million. The increase primarily reflects the continued rise in interest rates.

關於營運費用，在上次電話會議上，我們預測備考營運費用成長率將在23%至27%之間。我們正在調整預測，目前預計全年備考營運費用成長率將在23%至25%之間。我們正在調整2022年非現金股權激勵費用的預測，預計該費用將在5.2億美元至5.4億美元之間。我們也正在調整其他收入的預測，該收入主要包括利息收入，預計2022年該收入總額將在6000萬美元至7000萬美元之間，高於我們先前預測的5000萬美元至6000萬美元。此次調整主要反映了利率的持續上升。

On last quarter's call, we forecast 2022 capital expenditures within a range of $700 million to $900 million. We are now refining estimated capital expenditures for 2022 to be in the range of $700 million to $800 million. With regard to income tax, we continue to estimate our 2022 pro forma tax rate to be between 22% and 24% of pretax income.

在上季財報電話會議上，我們預測2022年資本支出將在7億至9億美元之間。目前，我們正在將2022年資本支出預估調整為7億至8億美元。關於所得稅，我們繼續預期2022年備考稅率為稅前利潤的22%至24%。

That concludes our prepared comments. We will now open the call to your questions.

我們的發言到此結束。現在開始接受各位提問。

(Operator Instructions) And we're going to begin today with Larry Biegelsen representing Wells Fargo.

（操作員說明）今天我們先請到代表富國銀行的拉里·比格爾森。

Gary, maybe if I could start with the supply constraints that you talked about, could you quantify how much you think that negatively impacted Q2? It sounds like they've been resolved. And Gary, obviously, people are worried about the impact of a recession. How are you better positioned this time compared to the last recession we saw in 2008, 2009? And I have one follow-up.

加里，或許我可以先談談你剛才提到的供應限制問題，你能量化一下你認為它對第二季度造成了多大的負面影響嗎？聽起來這些問題已經解決了。加里，顯然，大家都在擔心經濟衰退的影響。與2008年、2009年上次經濟衰退相比，你這次的因應措施有哪些優點？我還有一個後續問題。

Okay. On the supply constraint side, I'll give you a qualitative perspective and Jamie, you can fill in a little bit of a quantitative perspective. What's happening is semiconductor suppliers and some other raw material suppliers giving us choppy delivery time lines, so estimates that are sometimes moving around, and that can bring product in late in the quarter. When we assemble that product, it can sometimes make it hard at very quarter end to match system configurations to customers and that's largely what happened in Q2. Jamie, you want to add to that?

好的。關於供應限制方面，我先從定性角度談談，Jamie，你可以補充一些定量方面的內容。目前的情況是，半導體供應商和其他一些原料供應商的交貨時間不穩定，預估時間經常變動，這會導致產品在季度末才能到貨。當我們組裝這些產品時，有時會導致季度末難以將系統配置與客戶的需求相匹配，這在很大程度上就是第二季發生的情況。 Jamie，還有什麼要補充的嗎？

Think about the impact to Q2 placements roughly in the 5%-ish range in terms of without those supply constraints, those delayed semiconductor components the incremental systems that would have been delivered in Q2.

想想如果沒有這些供應限制、延遲交付的半導體組件以及原本會在第二季度交付的增量系統，第二季度的訂單量大概會受到 5% 左右的影響。

That continues to be choppy, and we expect, certainly for Q3 and perhaps forward that we'll continue to fight those fights in terms of timing of supply. On the second question -- the second part of your question on recession, clearly, our hospital customers are under financial pressure. We have seen that at the end of Q1 and had communicated with you at that time.

供應情況依然不穩定，我們預計，至少在第三季乃至未來一段時間內，我們仍需努力應對供應時間的挑戰。關於您第二個問題——也就是您提到的經濟衰退的第二部分，顯然，我們的醫院客戶正面臨財務壓力。我們在第一季末就已註意到這一點，並已就此與您溝通。

I think relative to where we were as Intuitive a decade ago, the size and strength of the installed base, the relative position that we have in terms of centrality to surgery and multiple disciplines and the expression of that in recurring revenue, the percentage of our business that's in recurring revenue, I think, gives us a little bit better shock absorption and predictability in terms of a large part of the revenue of the business. And gives us a few more degrees of freedom in terms of how we make our investments and time those investments relative to '08, '09.

我認為，與十年前Intuitive的狀況相比，我們現在的用戶基數規模和實力，我們在外科手術和多個學科領域的核心地位，以及這些優勢體現在經常性收入上，經常性收入占我們業務的比例，都讓我們在業務收入方面擁有了更好的抗衝擊性和可預測性。這也讓我們在投資方式和投資時機上擁有了更大的自由度，相較於2008年和2009年的情況，優勢更加明顯。

We are close with our customers. I am personally in contact with many. The trends that we've been describing to you, I think, we understood pretty well the size and duration of those trends in terms of pressure, very hard for any of us to predict. And you had a follow-on?

我們與客戶關係密切。我個人與很多客戶都有聯繫。我們之前向您描述的那些趨勢，我認為，我們對這些趨勢的規模和持續時間，以及它們帶來的壓力，都有相當清晰的認識，但這些趨勢的持續時間和壓力，對我們任何人來說都很難預測。您還有後續問題嗎？

Yes, that's all fair. Again, I'm going to push my luck a little bit here. FDA seems to be requiring clinical data for new systems. We know you have a new system in development. So my question is, do you know yet if FDA is going to require clinical data for your new system before approval? And if so, what can you share?

是的，這完全合理。不過，我還是想再問一個比較敏感的問題。 FDA似乎要求新系統提供臨床數據。我們知道貴公司正在研發新系統。所以我的問題是，您是否已經知道FDA是否會在批准前要求您提供新系統的臨床數據？如果需要，您能提供哪些資訊？

Looking at 2 things, I think let me broaden the question. Looking at the regulatory environment globally and in particular, in the United States and Europe, we have seen a trend in medical device and in robotic-assisted surgery for increasing data requirements. Sometimes those are trials, sometimes there are other kind of data. That trend has continued, and it's impacting all of us in the market, including Intuitive.

我想從兩個方面來探討這個問題。首先，從全球監管環境來看，尤其是在美國和歐洲，醫療器材和機器人輔助手術領域的資料需求呈現上升趨勢。這些數據有時是臨床試驗數據，有時則是其他類型的數據。這種趨勢仍在持續，並影響市場上的所有參與者，包括Intuitive公司。

You can expect that we will improve the Gen 4 product that's out there. We can get good ideas and technologies into our existing customer base hands and improve their utility, we will do that. We are, of course, working on next generations. And as I've said before, generations after that, without answering your question specifically, the deeper the technologic opportunities and the clinical impact, the more likely you have a deeper validation work to do.

您可以期待我們會改進現有的第四代產品。我們會將好的理念和技術推廣給現有客戶，並提升其實用性，我們一定會這樣做。當然，我們也在研發下一代產品。正如我之前所說，再往後的幾代產品，雖然我無法直接回答您的問題，但技術機會和臨床影響越深遠，就越有可能需要更深入的驗證工作。

And we're not afraid of that work. I'd rather do things that are really clinically meaningful for the customer. And if we have to do the work, then we'll do the work. I will say for everybody on the call, it's clear that relative to a decade ago, the investment trough and the time lines for new systems have both increased. The time lines have increased because of the changing regulatory environments in several countries. And as a result, the amount of investment that has to go into that has also changed. It's also increased.

我們並不害怕這項工作。我更願意做那些對客戶真正有臨床意義的事情。如果這項工作必須要做，我們就會去做。我想對在座的各位說，很明顯，與十年前相比，新系統的投資門檻和開發週期都提高了。開發週期延長是因為多個國家的監管環境發生了變化。因此，所需的投資額也隨之增加。

I think, and this is a prediction that it will also extend the useful life of products that we design. So it's taking a little longer to get to market than it used to, maybe more than a little, it's costing us more to get there. But that change in environment also means that really well-designed systems probably have longer useful life in the field. And I think we're starting to see that early evidence of that as well. So thank you for the question, Larry.

我認為，而且這只是我的預測，它還會延長我們設計的產品的使用壽命。所以，產品上市所需的時間比以前長了一些，或許不只長一些，成本也更高了。但這種環境變化也意味著，設計精良的系統在實際應用上的使用壽命可能會更長。而且我認為我們已經開始看到這方面的初步跡象。謝謝你的提問，拉里。

And next, we'll go to the line of Amit Hazan representing Goldman Sachs.

接下來，我們將連線代表高盛的阿米特·哈贊。

Maybe to come back to the supply chain question. I want to maybe ask it, different lens as kind of a bigger picture here, just given all the challenges you've gone through in the past 1.5 years or so. Do you have plans that change strategically in terms of evolving towards maybe regionalization or domestication of the supply chain? And how do we think about that and incremental costs that might come with that, if that's the plan? Or do you just plan to kind of ride this out and expect a more normal environment next year?

或許我們可以回到供應鏈的問題。我想從更宏觀的角度來看這個問題，考慮到過去一年半左右你們所經歷的種種挑戰。你們是否有策略性調整計劃，例如轉向供應鏈的區域化或本土化？如果這是你們的計劃，我們該如何看待由此可能產生的額外成本？還是你們只是打算暫時維持現狀，期待明年環境會更正常？

I'll start. And Jamie, you can lean in. First, I want to acknowledge our operating teams and the supply chain teams. They have done a spectacular job in the number of components that we manage in a robotic surgery system, both on the capital side and on the instruments and accessories side and the management of those supply chains is remarkable, perhaps bigger than most people expect relative to the size of our company. They have been really good at being proactive and thoughtful about supply chain, robustness about strategic reserves and about the ability to pivot into alternative components when we need to.

我先來。傑米，你可以靠過來。首先，我要感謝我們的營運團隊和供應鏈團隊。他們在機器人手術系統的組件管理方面做得非常出色，無論是資本方面還是器械和配件方面，他們都做得井井有條。這些供應鏈的管理更是令人矚目，其規模可能超出了大多數人對我們公司規模的預期。他們在供應鏈管理方面非常積極主動、考慮周全，策略儲備的穩健性以及在需要時迅速轉向替代組件的能力都做得非常出色。

And that has really been a spectacular performance. That's a long way of saying that they have been proactive. They will continue to be forward-looking and design for supply chain robustness. What that looks like depends a lot on the underlying product, whether it's creating second sources or using alternatives or thinking about regional deployment. We have been working through regional deployment prior to the pandemic, and we've done that work as we've gone on. That does incur some costs. We're thoughtful about it. And Jamie, why don't you provide your perspective?

這確實是一項卓越的表現。說穿了，就是他們一直積極主動。他們將繼續著眼未來，致力於打造穩健的供應鏈。具體做法很大程度上取決於產品本身，例如是否需要建立備用供應商、使用替代方案或考慮區域部署。在疫情爆發前，我們就已經開始著手區域部署，並在疫情期間持續推動這項工作。這確實會產生一些成本，我們會認真考慮。傑米，你能否分享一下你的看法？

From a strategic perspective or a long-term perspective, setting aside the current supply chain challenges, some of the things that we consider in our own long-term planning is the size of our business as it grows over time in the various regions that we serve, where you might locate, redundant capacity or incremental capacity. And in terms of the economic equation, you're trading the potential cost of redundancy with savings on freight and logistics to the extent that you can supply them in region.

從策略或長遠角度來看，撇開當前供應鏈的挑戰不談，我們在製定長期規劃時會考慮一些因素，例如隨著業務規模在各個服務區域的增長，以及可能的選址、冗餘產能或新增產能等問題。從經濟角度來看，我們需要權衡冗餘產能的潛在成本與區域內供貨所能帶來的貨運和物流成本節約。

That economic analysis is relatively straightforward. And really, you're just looking for the degree of redundancy you want and when does the regional businesses get big enough to warrant the economics. But certainly, what you described is something that we're looking at carefully and have been.

這種經濟分析相對簡單。實際上，你只需要確定你想要的冗餘程度，以及區域企業何時才能發展到足以支撐這種經濟效益的規模。當然，你所描述的情況正是我們認真研究並且一直在研究的。

And maybe just to hit on just earnings and going into the future with the components that you give us, it seems pretty clear this year, we're probably not going to get earnings growth. You had some interesting comments. It sounds like R&D, you're going to keep spending and you believe what you're doing organically that makes sense. And sir, if you have more comments on SG&A, but just thinking through, okay, no earnings this year, in terms of your commitment to shareholders, is it okay for you not to grow earnings next year, too? Would that become a bigger focus for you just given how this year has gone? How do you think about earnings growth after kind of what this year is going to end up looking like?

或許我們只談談獲利以及您提到的未來發展，但就您目前提供的資訊來看，今年獲利成長似乎不太可能實現。您之前的一些評論很有意思。聽起來您會繼續加大研發投入，並且認為目前的自然成長策略是合理的。先生，如果您對銷售、管理及行政費用（SG&A）還有其他補充，也歡迎您進一步說明。我們不妨思考一下，既然今年沒有獲利，那麼從您對股東的承諾來看，明年獲利成長是否也能接受？鑑於今年的情況，這是否會成為您更加關注的重點？考慮到今年的最終結果，您如何看待獲利成長？

Yes. So we're not going to get specific about '23 at this point. You'll obviously see us provide our outlook on the January call. What we're doing with respect to R&D currently is investing in multiyear projects and investments. You see that in our newer platforms, Ion and SP. We have obviously investments in digital, many of which are at an early stage. And we do continue to invest in, in the fourth generation ecosystem. And we look at the returns on those investments carefully and have confidence in them.

是的。所以目前我們不打算具體談2023年的情況。您當然會在1月的電話會議上看到我們的展望。目前，我們在研發方面主要投資於多年期專案。您可以在我們的新平台Ion和SP中看到這一點。我們顯然也在數位領域進行投資，其中許多項目尚處於早期階段。我們也持續投資第四代生態系。我們會認真評估這些投資的回報，並對其充滿信心。

But in part because of the regulatory time lines that Gary described, they are multiyear investments and we think that the returns there are quite attractive. And so that's why you see, for example, if you look at the first half, our R&D grew 30% relative to the overall growth of about 25% for OpEx. But if you take a multiyear view, given the growth opportunities that we see, you'd expect us to grow earnings over time.

但部分原因是由於Gary提到的監管時間表，這些都是多年投資，我們認為這些投資的回報相當可觀。因此，例如，如果您看一下上半年，您會發現我們的研發支出成長了30%，而營運支出整體成長率約為25%。但從多年角度來看，考慮到我們看到的成長機會，您會預期我們的利潤會隨著時間的推移而成長。

I'm not going to say whether that's '23 yet or not. And with respect to operating margins, specifically, what we've said is we look to be at the high end of our medtech peer set. And by medtech, that means high-growth companies that have growth opportunities as we see that we do.

我現在還不能確定這是否是2023年。至於具體的營業利潤率，我們之前說過，我們預計在同行業醫療科技公司中處於領先地位。這裡所說的醫療科技公司，指的是像我們這樣擁有成長機會的高成長公司。

I'll speak for a second on SG&A. We do have some infrastructure that is either needs to be built out to support the growth, particularly in manufacturing or we have some processes in IT and other parts of the business where we are long live on our pavement and there's some repaving or pot holes to fix that we will finish. We do expect to see highly targeted spending in that area going forward. And as we retire some of that project spend, we'll be thoughtful about where we go next. So we'll start to see some of that expense start to titrate into next year.

關於銷售、管理及行政費用（SG&A），我簡單說幾句。我們確實有一些基礎設施需要擴建以支援業務成長，尤其是在製造業方面；此外，我們在IT和其他業務部門也有一些流程需要改進，這些流程就像是長期營運的基礎設施，需要進行一些翻新或修補，我們會完成這些工作。我們預計未來將在這一領域投入大量資金。隨著部分專案支出的完成，我們會認真考慮下一步的計畫。因此，我們預計部分支出將逐步轉移到明年。

Your next question comes from the line of Travis Steed with Bank of America.

你的下一個問題來自美國銀行的崔維斯·史蒂德。

Gary, I'd love a little more color just on the overall hospital capital environment. Are you seeing hospitals just being more cautious on the near term? Or do you think we're in for a longer duration CapEx slowdown? I'm curious how you think the slowdown could range in terms of outcomes. If it's like '08 '09 or '13, '14 or 2020. And also like leases ticked up to 42% this quarter. I'm curious where you think that could peak in the slower CapEx environment?

加里，我想更詳細地了解醫院的整體資本環境。您認為醫院只是短期內更謹慎嗎？還是您認為資本支出放緩的趨勢會持續更長時間？我很想知道您認為這種放緩的程度會如何變化，例如會像 2008、2009 年、2013、2014 年還是 2020 年？另外，本季租賃支出成長了 42%，您認為在資本支出放緩的環境下，租賃支出會達到什麼高峰？

Yes. On the -- hard to predict the depths and duration of hospital pressure, so I won't. I will talk about what the -- I think what the inputs are, what they're faced with. Clearly, they're constrained on labor and the labor costs because of that constraint have gone up, that's not something that will resolve quickly. They're also facing inflationary pressure in some of their materials that they purchase. And they don't have enormous flexibility to change pricing on their side. So I would expect profitability constraint on the hospital side to be present.

是的。關於醫院壓力的深度和持續時間，很難預測，所以我不會妄下斷言。我會談談我認為的投入要素，以及他們面臨的困境。顯然，他們的勞動力供給受到限制，而勞動成本也因此上漲，這個問題短期內難以解決。此外，他們採購的部分材料也面臨通膨壓力。而且，他們本身在價格調整方面並沒有太大的彈性。因此，我預計醫院方面會面臨獲利能力方面的限制。

In light of that, one of their first tools in their toolkit is to try to get greater productivity out of existing assets and capital, and Intuitive will help them. If there is more productivity to get out of the products they already owned, we will help them do that. I still think there are hospitals out there that are going to be strategic, that are in better financial condition.

有鑑於此，他們首要的任務之一就是盡可能提高現有資產和資本的利用率，而Intuitive將為他們提供協助。如果他們已有的產品還有進步空間，我們會協助他們達成這個目標。我仍然認為，市場上會有一些醫院具有策略眼光，財務狀況也更好。

And if they want to build a new capacity and a new product line, SP or Ion or to branch out into a new region, then they'll do that and we'll help them do that as well. I don't think this is a 1- or 2-quarter resolution. It's certainly going to be something longer than that. With regard to change in lease and how do we think about leases going forward, Jamie, I'll ask you to take that.

如果他們想新建產能、開發新產品線（如SP或Ion），或是拓展到新的地區，他們會去做，我們也會幫助他們。我認為這不是一兩個季度就能解決的問題，肯定需要更長。至於租賃變更以及我們未來如何看待租賃問題，Jamie，請你來談談。

Yes. If I split between U.S. and OUS, what you've seen in the U.S. is relative maturity in understanding and acceptance use of our leasing program. It's been ticking up slowly over time. While it will fluctuate quarter-to-quarter based on customer preference, I do think that will slowly continue to tick up just based on what we hear from customers. In OUS, where we offer leasing, which is not in every market, we're at an earlier stage. And so you're seeing growing understanding and acceptance of leasing as an option as they acquire capital. And so I'd expect that to continue to climb over time.

是的。如果將美國和美國以外地區分開來看，在美國，我們看到的是客戶對我們租賃專案的理解和接受度相對較高，並且一直在穩步提升。雖然會根據客戶偏好逐季波動，但我認為根據我們從客戶那裡了解到的情況，這個數字會繼續緩慢增長。在美國以外地區，我們目前仍處於起步階段，因為我們並非所有市場都提供租賃服務。所以，隨著客戶資金的積累，他們對租賃作為選擇方案的理解和接受度也不斷提高。因此，我預計這個數字會隨著時間的推移而繼續增長。

Great. And I had one other question, Gary. Listened to your talk at SRS a few weeks ago, and you mentioned the time it takes to get new products to market is a couple of years longer. I think you said 6 to 8 years before, now 8 to 10 years. Love to kind of get in a little more detail on that assumption that you went through there. And I kind of think as I guess some it's mostly regulatory, but kind of dig into the comment a bit more and see how that's changed your strategic thinking in general of how you think about innovation and your product cycles at the moment.

太好了。我還有一個問題，Gary。幾週前我在SRS聽了你的演講，你提到新產品上市的時間要延長幾年。我記得你之前說的是6到8年，現在是8到10年。我想更詳細地了解你當時的假設。我猜想這主要是監管方面的原因，但我想更深入地探討一下，看看這如何改變了你目前對創新和產品週期的策略思考。

Yes. It was kind of a directional comment, more about averages than about a particular product line. So I discourage anybody looking at a particular product line and try to infer from it. We have a basket of things we do and on average, it's gotten longer. Strategically, I think there are a couple of things that strengthen the business that versus a decade ago that help us and give us more flexibility, more freedom. And that is both the deep penetration we have in the market, the large size of the customer base in terms of active users.

是的。這更多的是一種方向性的評論，更多的是關於平均值，而不是針對某個特定的產品線。所以我並不建議任何人只專注於某個特定的產品線並試圖從中推斷。我們有很多業務，而且平均而言，這個範圍越來越長。從策略角度來看，我認為有兩點增強了我們的業務實力，與十年前相比，這些優勢幫助我們獲得了更大的靈活性和自由。這兩點分別是我們在市場上的深度滲透以及龐大的活躍用戶群。

If we can get them a technology in increments, we're not as dependent on capital revenue as years passed. I think the recurring revenue side is a strength for us. If that increases productivity for the hospital, that's great. It turns out that, that gives them better financial returns on the investments they made, but also our economic profile is stronger in repeat use utilization than it is in capital change.

如果我們能逐步為他們提供技術，我們就不會像過去那樣依賴資本收入。我認為經常性收入是我們的優勢。如果這能提高醫院的生產力，那就太好了。事實證明，這不僅能讓他們獲得更高的投資回報，而且我們的經濟效益也反映在重複利用上，而不是資本投入。

So what that means to us is bring capital change when it really is differentiated, when it really brings incremental clinical value or new market access to our customers. And that's what we're focused on. With regard to the regulatory side, our goal is to be really good at it to get the right data we need at the right time to -- right the first time and take care of it. And those types of requirements ebb and flow over time, and we're in a particular state where the requirements are quite high, and we'll deal with it.

對我們而言，這意味著只有當資本變革真正具有差異化優勢，能夠為我們的客戶帶來增量臨床價值或新的市場准入時，我們才會進行投資。這正是我們關注的重點。在監管方面，我們的目標是做到精益求精，在正確的時間取得所需的正確數據，確保一次性成功並妥善處理。這類要求會隨著時間推移而變化，我們目前所處的州對監管的要求相當高，但我們會應對自如。

And we'll go to the line of Robbie Marcus, representing JPMorgan.

接下來，我們將連線摩根大通的代表羅比馬庫斯。

Great. Maybe to start, a lot of your comments, it feels like it's a U.S. comment in terms of the capital equipment. I want to get a sense, is there any difference in geography just given the hospitals, most of them outside the U.S., are dictated by single-payer country networks? And then I'll just ask a follow-up as well. Pretty good OUS procedure number. How do we think about how much of an impact the shutdowns in China had? And how should we be thinking about the ramp in second half on China just given that the country is still not on a strong pathway to a reopening?

好的。首先，您很多評論似乎都專注於美國，尤其是在資本設備方面。我想了解一下，考慮到醫院（其中大部分位於美國境外）都受單一支付方國家醫療體系的約束，地理位置是否存在差異？另外，我還有一個後續問題。 OUS（美國境外）的手術量相當不錯。我們該如何看待中國疫情封鎖的影響？鑑於中國目前仍未走上穩定重啟的道路，我們又該如何看待中國下半年的復甦？

Yes. Robbie, on that first question, it's a good one, and I appreciate it. Clearly, the utilization of systems and the posture of hospital acquisition relative to systems differs by country based on the maturity of our markets and the depth of penetration of da Vinci. We tried to call that out a little bit in the script. Jamie, I don't know if there's additional color you'd like to apply.

是的。羅比，關於第一個問題，問得很好，我很感謝。顯然，不同國家對系統的利用情況以及醫院在系統購置方面的態度會因市場成熟度和達文西手術系統的普及程度而異。我們在劇本中也稍微提到了這一點。傑米，我不知道你是否還有什麼補充。

Yes, I'd just say the softness in the U.S. capital pipeline is clear, and it's been clear for 2 quarters. What you saw in placements in Q2 was actually OUS placements grew as compared to a year ago, we haven't seen any clear and specific indications on capital weakness that I call out. Obviously, China had a challenging quarter with respect to procedures. But you look at the macro, you look at what's happening in Europe, you could imagine that, that might be a challenge as you look forward. But nothing that I call out at this point.

是的，我認為美國資本供應疲軟的跡像很明顯，而且已經持續了兩個季度。第二季的安置數據顯示，美國境外安置數量實際上比去年同期有所成長，我們還沒有看到任何需要特別指出的資本疲軟跡象。顯然，中國在程序方面經歷了一個充滿挑戰的季度。但從宏觀經濟角度來看，考慮到歐洲的情勢，我們可以預見，未來可能會面臨一些挑戰。但就目前而言，我還沒有特別指出什麼。

On -- you had asked kind of how do we expect China to proceed in procedures in the back half. Of course, that's impossible for us to predict. What I might ask, Brian, as you might just reiterate some of your comments is what's assumed in the model in terms of (inaudible)?

關於——你之前問過我們預計中國在後半程的程序上會如何進行。當然，這我們無法預測。布萊恩，我想問的是，你或許可以重申你的一些觀點，這個模型在（聽不清楚）方面做了哪些假設？

Yes. So we have seen, I'd say, at the end of Q2, we did see some improvement or recovery of procedures, I'd say probably closer to more normal levels over time. It's really hard to predict what's going to happen in China. I think they are our second largest market by procedure volume. It does have an impact when things do slow down, but you can see the procedure growth that we had despite the challenges in China. So I think it's probably a bit too soon to really give any color on what's going to happen there because there's just still so much variability. And frankly, we're still really early in the quarter.

是的。所以，我認為在第二季末，我們確實看到手術量有所改善或恢復，隨著時間的推移，手術量可能更接近正常水平。預測中國市場的發展趨勢真的很難。我認為中國是我們手術量第二大的市場。當市場放緩時，確實會產生影響，但你可以看到，儘管面臨挑戰，我們的手術量仍然實現了成長。因此，我認為現在就對中國市場的未來走向做出任何預測還為時過早，因為仍有太多不確定因素。坦白說，我們現在才剛開始這個季度。

And we have a question from Rick Wise, representing Stifel.

我們現在收到來自 Stifel 代表 Rick Wise 的提問。

Again, reflecting on history a little bit, when I think back to the end of the financial crisis to earlier last decade, obviously, there were periods of marked capital slowdown. And yes, those -- the recovery following that was in part a macro recovery, but it was also the -- in 2014, the launch of the Xi, it was a procedure volume uptake, expanded instruments. I mean there were many drivers of the recovery under the umbrella of the macro recovery.

再回顧歷史，回想一下金融危機結束到上個十年初，顯然，當時資本成長明顯放緩。沒錯，隨後的復甦部分是宏觀經濟復甦，但也得益於－2014年新冠疫情爆發，手術量增加，以及金融工具的擴張。我的意思是，在宏觀經濟復甦的大背景下，有許多因素推動了經濟復甦。

As we look ahead and think about the next few years, assuming a macro recovery occurs, I was just reflecting that the mix might be different this time. But what's -- the -- on the procedure side and the system or instrument side, I mean, what are the drivers that get us back to that accelerated growth again? Is it international instruments? And yes, inevitably a new system at some point or how would you talk about the next few years and thinking about a recovery from this period?

展望未來幾年，假設宏觀經濟復甦，我一直在思考，這次的情況可能會有所不同。但是，在程序和系統或工具方面，究竟是什麼因素能夠推動我們重回高速成長？是國際工具嗎？當然，在某個時候，新的系統勢必會出現。您會如何看待未來幾年，以及如何從這段時期中復甦？

Appreciate the question. In terms of drivers of growth, first, kind of zoom out, we are in the thick part of the adoption curve in the United States in general surgery across multiple sub-procedures. And there's real room there. I don't think we're saturated. And response has been really good and our training numbers and adoption and the underlying capability of our Gen 4 products has been great. So that's one.

感謝您的提問。就成長驅動因素而言，首先，從宏觀角度來看，我們在美國一般外科的多個子手術領域正處於產品普及的高峰期。而且，這個領域還有很大的成長空間。我認為市場尚未飽和。市場反應非常好，我們的培訓人數、產品普及率以及第四代產品的基礎表現都非常出色。這是一方面。

Two, we're seeing investments that we made many years ago in rounded teams, rounded Intuitive teams in key countries pay back now. And that has been fantastic. So it starts with growth in oncology -- oncologic surgical procedures outside of urology in addition to urology, so we're seeing that. But we're also seeing the early indications of adoption in benign surgery in OUS markets, which is, frankly, an exciting green shoot in the sense that, that could follow a pathway that mirrors what we saw in the U.S.

第二，我們看到多年前在關鍵國家對綜合團隊（即直覺型綜合團隊）的投資如今開始獲得回報。這真是太棒了。首先是腫瘤領域的成長——泌尿外科以外的腫瘤外科手術，以及泌尿外科本身，我們都看到了這方面的成長。但我們也看到了良性腫瘤手術在海外市場的早期發展跡象，坦白說，這是一個令人振奮的萌芽，因為它的發展路徑可能與我們在美國看到的情況類似。

So I think there's lots of opportunity there, and that has to do with bringing our instruments, our accessories, our ecosystem, our training capabilities, our data capabilities into our priority country markets over time. So we've got that. We have outstanding innovations that are coming to market. Ion is doing really well in the U.S. Ion will go deeper into other applications. We're trying to bring it to Europe in that process, we'll bring it to Asia over time.

所以我認為這裡蘊藏著許多機會，關鍵在於逐步將我們的儀器、配件、生態系統、培訓能力和資料能力引入我們的重點國家市場。我們已經做到了這一點。我們擁有即將推向市場的傑出創新成果。 Ion 在美國市場表現非常出色，未來也將拓展到其他應用領域。我們正在努力將其引入歐洲，並最終將其推向亞洲。

SP, SP is having great success in Korea. We're bringing it to Japan. We're working on additional indications for the United States. SP has differentiated capability. And as those indications get added and it's hard work, I think it will bring incremental procedures to our customers and then to us over time. And those are procedures that are either rarely done with da Vinci or not done with da Vinci at all. And I think that's another leg of opportunity.

SP系統在韓國取得了巨大成功。我們正在將其引入日本。我們也在努力開發更多其在美國的適應症。 SP系統擁有差異化的優勢。隨著這些適應症的不斷增加（這需要付出艱辛的努力），我認為它將逐步為我們的客戶，以及我們自己帶來更多手術選擇。這些手術要不是很少使用達文西手術系統，就是根本無法使用達文西手術系統。我認為這是另一個發展機會。

And how many years does it take? Well, they will layer out. Those things will layer out over time. In terms of regional performance, we have those opportunities in front of us right now. In terms of things like SP and Ion, SP is one of the more mature technologies and new platform. I think its economics are looking increasingly good for Intuitive and as they continue to knock down additional clinical indications, I think that will add strength.

那需要多少年呢？嗯，它們會逐步顯現。隨著時間的推移，這些事情都會逐漸明朗。就區域業績而言，我們目前就面臨這樣的機會。就SP和Ion這類產品而言，SP是較成熟的新技術和新平台之一。我認為它對Intuitive來說經濟效益越來越好，隨著他們不斷拓展臨床適應症，我認為這將增強其實力。

Ion has been growing like a weed. It's less mature in terms of its financial profile, but we're working hard on it. And so I think those things will contribute as well. So I think we have irons in the fire that we have confidence in.

Ion發展快速。雖然它的財務狀況還不夠成熟，但我們正在努力改進。所以我認為這些因素也會有所貢獻。因此，我認為我們目前有很多項目正在進行，而且我們對此充滿信心。

Okay. And just one last quick one for me. It's a little bit of a fishing expedition kind of question. Just reflecting on your comments about partnering with hospitals. One aspect is financially and with leases, et cetera. But I know you have many initiatives underway in terms of data collection and management. Any update in terms of your initiatives there? And is there anything on that side of the house we should be paying attention to?

好的。最後一個問題，算是試探性的問題。我剛才提到與醫院合作，一方面是財務方面，例如租賃等等。我知道你們在資料收集和管理方面有很多項目正在進行。這些項目有什麼最新進展嗎？這方面有什麼需要我們關注的嗎？

Thanks, Rick. On the basics, in our more mature da Vinci markets, our data facility and in terms of the ability to collect, analyze and share insight with our hospitals has been really good. And they are the things that allow them to compare the efficacy and efficiency of their da Vinci program. Relative to others in their own hospital group, relative to national and international norms, it allows them to make decisions about where capacity ought to go and where there are opportunities for improvement within their system.

謝謝，里克。就基本情況而言，在我們較成熟的達文西手術市場，我們的數據設施以及收集、分析和與醫院共享數據的能力都非常出色。這些優勢使他們能夠比較自身達文西手術計畫的有效性和效率。相對於同集團其他醫院、國內和國際標準，這有助於他們決定醫療資源應該投入哪些方面，以及系統內哪些方面存在改進空間。

We use that routinely. It is not a new idea. It's starting to become really baked into all the workflows and processes. We're automating a lot of that capability. So that's been fabulous. At the other end of the spectrum, we are engaged with a hard core health care researchers looking at what AI and our data sets can bring in terms of improved outcomes, personalized training, faster time to competency. And the excitement level there is quite high and we're continuing to invest down that pathway.

我們已經常規性地使用這項技術。它並非什麼新概念，而是正在逐步融入所有工作流程和程序中。我們正在實現許多相關功能的自動化，這非常棒。另一方面，我們也在與一些資深的醫療保健研究人員合作，探索人工智慧和我們的數據集在改善治療效果、個人化培訓以及加快技能提升速度等方面能夠帶來的益處。這方面的研究成果令人振奮，我們也將繼續加大投入。

So in one set, it's used every day and another set, I think it's in the innovation engines and it's informing discovery. And I believe those discoveries, in a few years, will change the nature of surgery and some of the training that we do. So I think there's an opportunity on both sides.

所以，一方面，它每天都在使用；另一方面，我認為它處於創新引擎中，為發現提供資訊。我相信，這些發現將在幾年內改變外科手術的性質以及我們的一些培訓方式。所以我認為雙方都有機會。

Just one last question, please.

最後一個問題，謝謝。

All right. Our final question today will come from the line of Richard Newitter representing Truist.

好的。我們今天的最後一個問題將來自代表 Truist 的 Richard Newitter。

Gary, just on that last answer. Can you give us any sense as to how, if and maybe even when you might look to begin monetizing those types of -- I don't want to say new alternative service models, things that might help hospitals become more efficient. Can we expect to see that filter into new sources of revenue streams and when? And are you already exploring that? And then I have one follow-up.

蓋瑞，就你剛才的回答而言，你能否透露一下，你打算如何、是否以及何時開始將這類——我不想說是新的替代服務模式，而是那些可能幫助醫院提高效率的措施——商業化？我們能否期待看到這些措施轉化為新的收入來源？何時實現？你是否已經在探索這方面了？我還有一個後續問題。

I -- we've said this before, in our digital efforts in terms of digital tools, some of them are -- the way we do our financial analysis, some of them are value creating through efficiency and labor savings on our side or on the hospital side and the investments are really a reduction in our cost to serve. So that's one category.

我之前說過，在數位轉型方面，就數位化工具而言，有些工具——例如我們進行財務分析的方式——透過提高效率和節省人力來創造價值，無論是對我們還是對醫院而言，這些投資實際上都降低了我們的服務成本。這是其中一類。

There's another category that is around accelerated time to competency that lowers our cost to serve through having people get through their implementation and programmatic processes more quickly. The third category is direct revenue opportunity. We have things in the field working in all 3 of those categories. So none of them is empty.

還有一類是加速提升能力，進而降低服務成本，讓人們更快完成實施和專案流程。第三類是直接收入機會。我們在所有這三類領域都有實際專案在運作，所以沒有一類是空白的。

In terms of pricing and customer acceptance of our value proposition, we are out in our training opportunities in some of our augmented reality spaces and in our Intuitive Hub starting to explore those. Some of them are very, very early. Some of them are reasonably mature in terms of what our pricing and other models look like. What I would tell you is that relative to other sources of revenue, these should be accretive to our bottom line because of some of the cost savings, but they won't be huge revenue lines in the near term. I would not set the expectation that all of that turns into big time revenue.

就定價和客戶對我們價值主張的接受度而言，我們正在一些擴增實境空間和直覺中心開展培訓項目，並開始探索這些領域。其中一些項目還處於非常早期的階段，而另一些項目在定價和其他模式方面已經相當成熟。我想說的是，相對於其他收入來源，由於成本節約，這些項目應該能夠提升我們的利潤，但短期內不會成為龐大的收入來源。我並不認為所有這些項目最終都能帶來巨額收入。

Our biggest thing and our focus is to help customers, hospitals get to great, high-functioning, minimally invasive surgery programs using our products. If we do that, then they will find a way to pay us. And so far, that economic engine has worked well for them and it's worked well for us.

我們最重要的目標和工作重點是幫助客戶和醫院利用我們的產品建立高效、便利、微創的手術專案。如果我們做到了這一點，他們自然會想辦法支付我們的費用。到目前為止，這種經濟模式對他們和我們都非常有效。

Great. And just -- you guys mentioned TORS, I believe, where SP is gaining traction. You've got 20% penetration. I think you estimated -- of U.S. estimated procedures. Just remind us, how big of a category is TORS? Can you quantify that for us? And where do you think something like that could go? Or where are some of your more aggressive users in terms of their penetration already?

太好了。對了，你們剛才提到了經口機器人手術（TORS），我記得SP（可能是指某種手術或治療方法）在這方面越來越受歡迎。你們的滲透率達到了20%。我記得你們估計過，這是美國手術量的20%。請問TORS究竟有多大？你們能具體說說嗎？你們覺得這種手術的發展前景如何？或者說，目前你們一些比較積極的用戶在滲透率方面的情況如何？

Yes. On the micro question, so that was malignant TORS. It's a small but high-value segment. Roughly TAM number of surgeries performed is in the 10,000 per year range. So a relatively small market. But like I said, for surgeons and patients, really high value. In terms of where it might go, I'll let Gary expand on that.

是的。關於微觀層面的問題，那就是惡性腫瘤經口機器人手術（TORS）。這是一個規模雖小但價值極高的細分市場。據估計，每年進行的此類手術數量約為1萬例。所以市場相對較小。但正如我所說，對於外科醫生和患者而言，其價值非常高。至於未來的發展方向，我請Gary來詳細說明。

Yes. I think that SP and narrow access surgery has opportunities to extend the kinds of procedures that are done robotically and we'll look to Korea as a guide in that they have broad clearances. And they're using it all over the body from gynecology to breast oncology and other things where they see value. And I think that as that clinical evidence comes through and as the clearances expand, you'll see incremental opportunity that is reasonable for us and, I think, exciting for our customer base. We'll detail those things further in future calls as that data starts to publish.

是的。我認為SP和窄切口手術有機會拓展機器人手術的應用範圍，我們將以韓國為榜樣，因為他們的手術適應症非常廣泛。他們正在將這項技術應用於全身各部位，從婦科到乳房腫瘤，以及其他他們認為有價值的領域。我認為，隨著臨床證據的不斷累積和適應症的擴大，我們將看到更多合理的發展機遇，這對我們的客戶群來說也是令人興奮的。隨著相關數據的陸續公佈，我們將在未來的電話會議中進一步闡述這些內容。

That was our last question. In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple lane: Better, more predictable patient outcomes, better experiences for patients, better experiences for their teams and ultimately, a lower total cost of care.

這是我們的最後一個問題。最後，我們仍然相信，在從根本上改善外科手術和急診介入方面，存在著巨大且持久的機會。我們的團隊將繼續與醫院、醫生和護理團隊緊密合作，追求客戶所說的「四重目標」：更佳、更可預測的病患治療效果，更佳的病患體驗，更佳的醫護團隊體驗，以及最終更低的醫療總成本。

We believe value creation in surgery and acute care is foundationally human. It follows from respect for and understanding of patients and care teams, their needs and their environment. At Intuitive, we envision a future of care that is less invasive and profoundly better where diseases are identified earlier and treated quickly so patients can get back to what matters most. Thank you for your support on this extraordinary journey. We look forward to talking with you again in 3 months.

我們相信，外科手術和急診護理的價值創造以人為本。這源於對患者及其照護團隊、他們的需求以及他們所處環境的尊重和理解。在Intuitive，我們展望未來，希望醫療照護更加微創、更有高效，能夠更早發現疾病並迅速治療，讓患者盡快回歸最重要的生活。感謝您在這段非凡旅程中給予的支持。我們期待三個月後與您再次交流。

Ladies and gentlemen, that does conclude our conference for today. We thank you for your participation and using the AT&T Event Services. You may now disconnect.

女士們、先生們，今天的會議到此結束。感謝您的參與及使用AT&T活動服務。您現在可以斷開連線了。